The deeper I get into my medical education the more I feel as though a bioethicist cannot function professionally only on that title and education, rather it seems as though the integration of bioethics into a larger field such as medicine or law is a necessity. As an aspiring physician, I had contemplated the valuable interplay of clinical or legal knowledge and bioethics but the viability of a distinct profession labeled bioethicist appeared equally viable. In retrospect, however, it seems intuitive that bioethics cannot exist in isolation given that its conceptual roots themselves lay in a hybrid of moral philosophy and the very real world practice of research or clinical care. This seeming inability to properly survive in isolation may be fortunate however given a number of examples from the history of clinical consultation.
The value of melding another more patient/client-centered profession with bioethics is demonstrated by anecdotes of bioethicists whose purely philosophical training led them to be more enticed by theory than by practical questions of patient welfare. Doctors attempting to resolve basic questions of fact, and to assess proper medical treatment per fact, “increasingly find themselves instead wandering down Wittgensteinian byways and into Kantian cul-de-sacs” by this breed of bioethicist. The case of the philosopher James Reagan offers ample evidence of this divide.
Reagan routinely delivered carefully typed-out speeches on the importance of ethical principles putting his colleagues in the hospital to sleep. He fared no better when he tried to explain the moral fine points of withdrawing a patient from life support. Based on theory he proposed that “the withholding of treatment does not, technically speaking, kill a patient,” bringing into the conversation the four hypotheticals of double-effect reasoning. The response was less than ideal. Far from being wowed by his complex theory the listening physicians called him a murderer. In light of such anecdotes, it becomes apparent that having direct clinical experience is invaluable in cases of treatment-related ethics decision making.
Given the complexity of the issues involved and need for comprehensive training, it may seem strange that bioethics functions better when united with another equally demanding profession, yet when we examine past foibles within the field this very much seems to be the case